Perscription drugs spilling out of their container, on toap of one hundred dollar bills.
Medicare Part D spending for 10 selected diabetes drugs surged from $7.7 billion in 2019 to $35.8 billion in 2023, an audit by the U.S. Department of Health and Human Services Office of Inspector General found.
At the same time, Part D spending for Ozempic increased from $552 million to $9.2 billion and the number of Part D enrollees filling a prescription for Ozempic increased from 142,479 to 1,465,482 (a 929% increase).
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“This substantial increase could have a financial impact on the Medicare program,” the report said. “Medicare Part D does not cover drugs prescribed for weight loss. Therefore, the surge in utilization of these drugs by Medicare Part D enrollees merits further inquiry to determine whether the drug claims were paid in accordance with Medicare requirements. Information in this data brief may be beneficial to CMS and other agencies when developing future program guidance related to these drugs.”
Researchers broke down spending by drug brand:
- Part D spending for six of the diabetes drugs (Rybelsus, Ozempic, Mounjaro, Farxiga, Jardiance and Trulicity) substantially increased from 2019 to 2023.
- Part D spending on Rybelsus, the only GLP-1 oral drug, experienced the largest increase during the audit period. In the product’s initial year, 2019, spending was $366,443 in its first three months of coverage. From 2020 to 2023, spending increased to almost $1.7 billion, a hike of 2,182%.
- Part D spending for Ozempic was 16 times greater in 2023 than in 2019, with spending almost doubling every year under review.
- Although Mounjaro was not covered by Medicare Part D until May 2022, spending increased by 1,541% the next year.
If the annual percentage increase in spending continues at a rate of 42% (the smallest annual rate of increase observed during the audit period), it potentially could amount to more than $102 billion in Medicare Part D spending on the 10 selected drugs in 2026.
“These increases merit further inquiry to determine whether prescription drug event records were paid in accordance with Medicare requirements and whether the associated drugs were utilized for medically accepted indications,” the report concluded. “The Office of Inspector General plans to conduct additional audits related to Medicare Part D utilization of and spending for select diabetes drugs to determine whether diabetes drugs were paid for in accordance with federal requirements.”
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Alan Goforth
Alan Goforth is a freelance writer in suburban Kansas City. In addition to freelancing for several publications, he has written a dozen books about sports and other topics.
